Buerger's disease revisited

Different immunophenotypes in Buerger's disease

Recently, we reviewed the morphology of 31 specimens of thromboangiitis obliterans (TAO, Buerger's disease) in a multivariate analysis and showed that certain novel features of the affected vessels are different from arteriosclerosis obliterans (ASO) and thromboembolism. However, the pathogenic concept of TAO is still controversial. We applied immunohistochemistry to 58 amputated lower extremities and five autopsy controls. At specific sites of the diseased vessels, different cellular components were immunotyped by CD3, CD4, CD20, CD31, CD68, actin and desmin. These results were carefully compared among different diagnostic groups of vasoocclusive lesions by statistical methods. Some unique characteristics of TAO were identified when compared with ASO or thromboembolism. Consistent with a primary inflammatory and immunogenic lesion, lymphocytes and especially CD4+ T cells emerged significantly in TAO vessels and their adventitia. In the subset of definite TAO cases defined by all clinical criteria, the linear arrangement of macrophages, and B- and T-lymphocytes along vascular elastic fibers was the most striking additional finding, suggesting elastic fibers are an important immunogen. However, this feature was not apparent in closely related cases, otherwise similar to TAO and different from ASO and thromboembolism. Thus, our results indicate a heterogeneous group of TAO diseases, suggesting that damage to elastic fibers may be a secondary change to primary inflammation.

Multiple ulcers with perforation of the small intestine in buerger's disease: a case report

We present the case of a young man with Buerger's disease that involved the gastrointestinal tract. The patient experienced sudden onset of abdominal pain during the period of treatment for peripheral manifestations. Radiographic workup revealed free air in the abdomen. A laparotomy was performed, and the resected specimen revealed regularly distanced and multiple ulcers in proximity of the perforation, which was accompanied by occluded intramural arteries of the small intestine. Although visceral localization of Buerger's disease is unusual, several cases have been previously reported. Nevertheless, the manifestation of regularly distanced skip intestinal ulcers in Buerger's disease is apparently unique. In addition, detailed pathological findings delineated this rare condition.

Buerger's disease in a middle-aged woman with diabetes mellitus. A case report

Buerger's disease or thromboangiitis obliterans with involvement of small arteries of the upper and lower extremities usually afflicts young male smokers, but this report presents a middle-age female nonsmoker with diabetes mellitus who satisfied clinical, angiographic and histologic criteria for the diagnosis of Buerger's disease.

Superficial thrombophlebitis. II. Secondary hypercoagulable states

Secondary hypercoagulable states are complex clinical conditions associated with an increased risk of thrombosis in which the exact pathophysiology is poorly understood. Secondary causes of superficial thrombophlebitis include malignancy, pregnancy, use of oral contraceptives, infusion of prothrombin complex concentrates, Behçet's disease, Buerger's disease, Mondor's disease, infectious agents, conditions that promote venous stasis, intravenous catheters and intravenous drug use. Conditions that may stimulate superficial thrombophlebitis include dermatophyte cellulitis at saphenous phlebectomy sites, sarcoidal granulomas, cutaneous polyarteritis nodosa, and hyperalgesic pseudothrombophlebitis in patients who test positive for human immunodeficiency virus. The distinguishing features, clinical evaluation, treatment, and histologic characteristics of the various disorders are reviewed.

Intraoral manifestation of thromboangiitis obliterans (Buerger's disease)

A case of thromboangiitis obliterans (Buerger's disease) showing vascular lesions in the oral cavity is presented. To our knowledge, this is the first report of involvement of branches of the external carotid artery with this disease. The clinical, radiographic, plethysmographic, and histologic features of Buerger's disease are presented. Etiologic factors, pathogenesis, and treatment modalities are discussed.

The rise and fall and resurgence of thromboangiitis obliterans (Buerger's disease)

Thromboangiitis obliterans (TAO; or Buerger's disease) is a nonarteriosclerotic, segmental, occlusive inflammatory disease of medium-sized and small arteries and veins of unknown cause, occurring predominantly in young male habitual tobacco users. Less than 2% of the patients with TAO are women or elderly persons. TAO is a treatable disease when diagnosed early and if strict abstinence from tobacco is observed. Otherwise progression and exacerbation of limb ischemia may lead to multiple and repeated amputations, and rarely visceral or cerebral ischemia. Over a 40-year period, 1947 to 1986, the prevalence rate of the diagnosis of TAO has declined steadily from 104/100,000 in 1947 to 13/100,000 in 1986 (an 8-fold decrease) where clinical and pathologic criteria for the diagnosis of TAO have remained unchanged. A similar pattern of decline was observed in two other major medical centers. Twelve women and 97 men with TAO were identified in the 5-year period 1981-1985. The 11% (12 of 109) incidence of female TAO was 10-fold that was previously reported. All 12 women were heavy smokers; 8 (67%) had thrombophlebitis and 6 (50%) had upper limb ischemia. Nine (75%) of 12 women required amputations; delay in diagnosis contributed to additional amputations in 2 patients. The increased prevalence of TAO in women may be attributed to the smoking habit in young women overall, which has increased significantly rather than decreased (as in males) since 1965.

Thromboangiitis obliterans (Buerger's disease) in an elderly man after cessation of cigarette smoking--a case report

Thromboangiitis obliterans (Buerger's disease) is an occlusive vascular disease that occurs almost exclusively in young male tobacco users. A unique case is documented here in which Buerger's disease affecting the upper limbs was diagnosed in a sixty-two-year-old man who was a cigarette smoker but had stopped smoking fifteen years earlier.

Thromboangiitis obliterans (Buerger's disease) in a saphenous vein arterial graft

Thromboangiitis obliterans (Buerger's disease) is an uncommon variety of occlusive peripheral vascular disease, occurring predominantly in young male tobacco smokers. The vascular lesion in the acute stage of thromboangiitis obliterans is distinctive and affects both the arteries and veins. Described here is an unusual case of thromboangiitis obliterans occurring in a saphenous vein used for coronary artery bypass graft in a middle-aged man who, against advice, had continued to smoke after the myocardial revascularization surgery. To the author's knowledge, thromboangiitis obliterans in arterial vein graft has not been reported previously.

Buerger's disease in a young woman

Buerger's disease or thromboangiitis obliterans is characterized by peripheral arterial occlusions in young male cigarette smokers. It is rarely considered in the differential diagnosis of vascular disease in women, although there have been several well-documented cases in the literature. This report presents a young woman with both angiographic and histopathologic evidence for Buerger's disease who was initially treated with daily corticosteroids for presumed vasculitis. This case emphasizes the fact that Buerger's disease can present in a fashion similar to both vasculitis and collagen vascular disease.

Buerger's disease revisited

TAO is a distinct, pathologic, and clinical disease process. Its diagnosis can be arrived at with a reasonable degree of certainty by the clinical history, angiographic findings, and pathology. Tobacco plays a very important part in the etiology of the disease process and must be completely avoided in any form for successful treatment. Four-extremity arteriography is recommended to assess the present nature of the disease and for a comparison at a later date. Direct arterial surgery is seldom feasible because of the distal and segmental nature of TAO. Sympathectomy can be helpful if combined with elimination of tobacco and quiescence of the disease. Meticulous local therapy to the ischemic tissue with control of infection and precise amputation if necessary is extremely important.

Lipid metabolism of the arterial wall in thromboangiitis obliterans (Buerger's disease)

The uptake and incorporation of [I14-C] oleic acid by diseased arterial intima removed by thrombendarteriectomy in 3 patients with Thromboangiitis obliterans (TAO) was studied. The diagnosis of TAO had been established by clinical, angiographic and histological criteria. The uptake and distribution of the label was found very similar in TAO and normal intima and differed considerably from atherosclerotic intima, from fatty streaks as well as from fibro-fatty lesions. In fatty streak lesions the incorporation of [I14-C] oleic acid into phospholipid, triglyceride and cholesterol ester was significantly increased compared to TAO, normal intima and unbilical artery. In TAO the distribution of labeled lipids between subcellular fractions of the arterial intima was also studied and, as in normal intima, most of the cholesterol ester were found membrane-bound whereas in fibro-fatty lesions the bulk of the cholesterol ester was present in the lipid skin fraction. The incorporation of [I14-C] oleic acid into different phospholipids was highest in atherosclerotic intima while no significant differences were found between normal intima and TAO. These data suggest a different pathogenesis of TAO and atherosclerosis.